I am a Disease: Where is my Drug?! Dalhousie University January 20, 2011 Marlene E. Haffner, MD, MPH 1

2011 We treat symptoms, but seldom cure – except with antibiotics With the discovery of the Human Genome sequence we may be closer to cures – personalized medicine Many – probably most - diseases do not have cures Many diseases will “divide.” In the future will describe a disease in genomic terms rather than in terms of phenotype 2

Goals and Objectives 1.Describe how FDA works – what they do and do not do 2.Discuss a bit of the regulatory history of FDA 3.Discuss the coming to pass of the US Orphan Drug Act (ODA) 4.What has occurred in the last almost 30 years since passage of the ODA and the effect on patients around the world 3

 The FDA  Promotes and protects the public health by ensuring consumers have access to safe foods and safe and effective medical products, including drugs, biologics and medical devices  It is one of the world‘s most admired consumer protection agencies and is widely respected for its leadership in science-based regulation.  FDA-regulated products account for almost 25 cents of every consumer dollar spent in the United States 4

WHAT DOES THE FDA DO? FDA is a regulatory agency of the Department of Health and Human Services Has the authority to review the science which assures safety and efficacy of drugs, devices, biological preparations prior to marketing in the United States Can also cause to be removed products that are not safe or effective – risk/benefit equation FDA does some research, but does not do drug development research Comprised of many dedicated scientists – physicians, PhD’s, pharmacists, nurses, engineers, and others throughout the US – the majority in the Washington, DC area. More than 8000 total employees Budget of ~$2.5 billion 5

How Far Have We Come ?... 6

Selected History of Biologics and Drug Regulation 1902 Biologics Control Act – in response to the death of 13 children in St Louis. Signed by President Theodore Roosevelt 1906 – Food and Drug Act – prohibited interstate commerce of misbranded and adulterated food, drinks and drugs 7

Dawn of the Modern FD &C Act – 1938 The result of elixir of sulanilimide used as a diluent 107 children died Extended control to cosmetics and therapeutic devices. Required new drugs to be shown safe before marketing- starting a new system of drug regulation. Provided that safe tolerances be set for unavoidable poisonous substances. Authorized factory inspections. Signed by FD Roosevelt 8

1962 Federal Food, Drug & Cosmetic Act Thalidomide induced congenital defects Establishment of effectiveness as a pre-market requirement 1976 Medical Device Amendments Formalized device authorities Established tiered risk based system 1983 Orphan Drug Act 1997 FDA Modernization Act 2007 FDA Amendments Act (FDAAA) 9

DrugDiscoveryAnimalTesting Approval PostMarketing Human Testing Phase I Phase II Phase III years Preclinical Development year years 6 months - 1 year years $1.2 Billion New Drug Development INDNDA 10

Overview of Therapeutic Development Pre-IND 1234 Pre-clinical Screening, animal studies, chemistry, batching Consultation IND FilingNDA Filing Pre-IND Meeting End of Phase 2 Meeting Pre- NDA Meeting 30 day multidisciplinary safety review Comprehensive multidisciplinary review often with Advisory Committee discussion Initial dose finding and safety studies Initial activity and further safety studies Comparative efficacy studies, chemistry scale up, prepare NDA Post marketing safety review, other commitments Monitor safety, review new protocols, annual reports, approve exceptions Safety and Phase 4 monitoring Sponsor 11

WHY DOES IT TAKE SO LONG? HOW CAN WE SHORTEN THE TIME? 12

Enter the US ODA Established incentives to the development of products to treat rare disease - <200,000 in the US Result of years of study as to the best Incentives – “Significant Drugs of Limited Commercial Value” Consumer Groups support/activism 13

Incentives Designation of Drugs and biologics as orphans Tax credits for clinical development Grants to academia for clinical development Protocol Assistance Exclusivity Waiver of Prescription Drug User Fees ($1.4+ m in 2011) 14

Establishment of the Office of Orphan Products Development Review products for designation as an orphan drug Review devices for Humanitarian Devices Serve as ombudsman within FDA for the product Serve as translator for “FDA speak” Administer the Orphan Products Grants program Coordinate with CDER Orphan Drugs Assoc. Dir. 15

What is an Orphan Disease Affects fewer than 200,000 in the US May affect a disease common in the developing world Examples –Malaria –Active TB –Childhood leukemias –PKU –Many genetic diseases 16

Characteristics of Orphan Diseases 90% Severe or Life Threatening ~50% Occur in Children > 90% have no therapy Life history of the disease is not known well Heterogeneous Patients hard to find Few specialists Diagnosis frequently takes years 17

Since 1983 More than 2000 products designated as orphan products Almost 400 products approved as orphan products Grants program has seen 40+ products approved Orphan products programs in EU, Japan, Taiwan, Australia, and beyond Many firms-large and small built around orphan drugs Consumer groups increasingly proactive 18

ISSUES Biotech products are expensive – many newer orphan products are biotech. How does one calculate expense of drug/expense of disease/value of treatment On approval have a very effective drug but little is known of safety ---REMS to assure safety – adds to cost 19

The Whole Story More than 19 million in the US can have benefitted from an orphan product approved by the US FDA Many technological breakthroughs have come via orphan drug research and development –Pegylation –Liposomal encapsulation World wide acceptance of the orphan product paradigm “Rare Diseases are not Rare” estimated at 10 – 15% of the population 20

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.”.... Margaret Meade 21

? Marlene E. Haffner, MD, MPH M 22

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